School SBIRT Implementation Project Application-DEADLINE SEPTEMBER 22, 2023! New and Returning Schools

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Schools can apply to be part of a School SBIRT Implementation Project Cohort 2023-2024. Each school that participates is eligible for a $2,000 stipend upon meeting project requirements. A maximum of $4,000 per district.

Please complete the following application with your team. Applications are due no later than 4 PM on Friday, September 22, 2023. Schools will be notified by early October.

Questions can be directed to:
• Tracy Herlitzke, WISH Center Director, therlitzke@cesa4.org
• Alie Hubing, WISH Center Project Coordinator, ahubing@cesa4.org

Email *

By checking the box, you are committing to the project requirements: *

Identify a District Administrator/School Leader to engage in decision making and problem solving for project implementation.

Identify an existing team or create a SBIRT Implementation Team. The team will be comprised of participating Practitioners, designated Leader/Administrator, and Team Lead.

New staff (not previously trained) must complete pre-learning, 2 days of in person training, practice sample submission for fidelity review, and regular self-assessments of practice.

FOR RETURNING SCHOOLS - Returning Practitioners must participate in a 2 hour virtual Booster Session.

Each practitioner delivers SBIRT to 1-2 new students per month and track data.

School SBIRT Team Lead & each practitioner participates in 2 virtual follow-up community of practice sessions.

Each team will receive a customized Google Dashboard to enter their data on a monthly basis for implementation feedback.

School SBIRT Team Lead submits a final SBIRT data dashboard and summary survey to WISH Center Director at the end of the year for project evaluation and reporting.

Required

Clear form

Never submit passwords through Google Forms.

This form was created inside of Cooperative Education Service Agency #4. Report Abuse

Forms